Who’s brainwashed?

Editor’s note: The following article is a Q&A with Sally Satel written by Kathryn Jean Lopez. It originally appeared on National Review Online on June 5, 2013.

You don’t have to be a brain surgeon to find the subject of how our brains work fascinating. As Sally Satel points out in an interview with National Review Online’s Kathryn Jean Lopez, because the “brain is a very attractive topic to both readers and journalists . . . the sheer numbers of articles present many opportunities for the dissemination of overwrought claims.”

But when news about the brain becomes hype, it can become a disseminator of “false hope and false answers.” As we look at the mechanics of the brain, we shouldn’t “become too carried away with the notion that we are our brains and, hence, not responsible — a message that lay people often take away from discussions about the neural underpinnings of behavior,” Satel cautions. In our daydreaming about a fascinating topic, “we may impede one of the most challenging cultural projects looming in the years ahead: how to reconcile advances in brain science with personal, legal, and civic notions of freedom.”

Satel, a psychiatrist with a “a set of twitchy antennae for politicization of science” and Scott O. Lilienfeld, a psychologist who teaches at Emory University, are authors of the new book, released today, Brainwashed: The Seductive Appeal of Mindless Neuroscience.

KATHRYN JEAN LOPEZ: Who are the “brainwashed”? Who made neuroscience “mindless”?

SALLY SATEL: Non-experts are at risk of being seduced into believing that brain science, and brain imaging in particular, can unlock the secrets of human nature. The media often purvey information about studies of the brain in uncritical ways that foster misimpressions of what brain science can reveal about the mind — and none are more chagrinned about this state of affairs than neuroscientists themselves and the careful science journalists who report on their work.

My co-author, psychologist Scott Lilienfeld, and I talk about “losing the mind in the age of brain science.” By this we mean that brain-based levels of explanation are regarded, more and more, as the most authentic and valued way of explaining human behavior. Sometimes, this is indeed the proper way to go (when we want to uncover the workings of the brain for clinical purposes or to achieve new insight about the mechanisms of memory, learning, emotion, and so on). But understanding people in the context of their lives — their desires, intentions, attitudes, feelings, and so on — requires that we ask them, not their brains.

To be clear, all subjective experience, from a frisson of excitement to the ache of longing, corresponds to physical events in the brain. Scientists have made great strides in reducing the organizational complexity of the brain from the intact organ to its constituent neurons, the proteins they contain, genes, and so on. Just as one obtains differing perspectives on the layout of a sprawling city while ascending in a skyscraper’s glass elevator, we can gather different insights into human behavior at different levels of analysis.

Using this template, we can see how human thought and action unfold at a number of explanatory levels, working upward from the most basic elements. A major point we make in Brainwashed is that problems arise when we ascribe too much importance to the brain-based explanations and not enough to psychological or social ones.

LOPEZ: Why are we so fascinated with the brain?

SATEL: The brain is more complex than any structure in the known cosmos. How this enormous neural edifice gives rise to subjective feelings and our sense of self is one of the greatest mysteries of science and philosophy.

LOPEZ: What do you mean by the expression “this is your brain on Ahmadinejad”?

SATEL: That’s our way of describing a dubious attempt to ascertain subjects’ attitudes about political figures by scanning their brains as they watched video clips and photos of these figures.

A few years ago, the Atlantic journalist Jeffrey Goldberg submitted to a brain scan in an attempt to clarify his political disposition. (Yes, political operatives have collaborated with researchers to develop a way to assess voters’ impressions of candidates via brain scan — and one of them asked Goldberg, with a straight face, as far as I can tell from Goldberg’s account, to participate.) It turned out that Goldberg’s brain responded to an image of Ahmadinejad in a manner that suggested pleasurable anticipation, according to the researchers. After his adventure in “vanity scanning,” as Goldberg called it, he wondered “to what degree this was truly scientific and to what degree it was 21st-century phrenology.” Goldberg isn’t the first to express such doubts. Frustrated experts have also dubbed over eager readings of fMRI images “neophrenology.”

The analogy is not really fair. Unlike phrenology, brain imaging is a technological marvel that does reveal something about the relationship between brain and mind. But exactly what can a “lit” brain region really tell us about an individual’s thoughts and feelings? We devote a chapter to explaining why brain scans are not anything remotely like photographs of the brain in action in real time. Scientists can’t just look “in” the brain and see what it does. They cannot “read” minds. More accurately, scans produced by functional magnetic resonance imaging (fMRI) tell us which areas in the brain are working the hardest, as measured by increased oxygen consumption, when a subject performs a task such as reading a passage or reacting to stimuli such as pictures or sounds.

The problem is that almost all regions of the brain have not just one but several job descriptions, which can make interpretation of scans a challenge. The multi-functionality of most brain areas renders reasoning backwards from neural activation depicted by a scan to the subjective experience of the brain’s owner a dubious strategy. Formally, this logically suspect approach is called “reverse inference,” and when crudely applied it functions much like a high-tech Rorschach test, inviting interpreters to read what they want into largely ambiguous findings.

In fact, researchers are now using techniques that measure the nature of brain activity in more informative ways. Increasingly, they are moving away from the time-honored approach of examining which discrete brain areas “light up” and toward the study of the brain as it operates in nature: as the electrical crackling of crosstalk among numerous regions as they are strung together in specialized neural circuits that work in parallel to produce our thoughts and feelings.

LOPEZ: Is there any practical use of fMRI for us laymen?

SATEL: Yes, there is enormous practical importance. Neurosurgeons increasingly enlist fMRI in pre-surgical planning. They use fMRI to map the language and motor regions of the brain to minimize damage to these functionally important areas in removing a tumor, blood clot, or epileptic tissue. Brain mapping has also been invaluable in pinpointing some of the central sites of defective activity in patients with severe, chronic depression or obsessive-compulsive disorder, allowing for optimal placement of therapeutic electrodes to stimulate the affected areas, a technique called deep brain stimulation. It is also used to ascertain stroke damage, to follow the course of Alzheimer’s disease and epilepsy, and to determine brain maturity. Scientists hope that fMRI will improve the treatment of comatose patients by allowing doctors to directly measure levels of consciousness.

LOPEZ: What is brain science realistically on the verge of?

SATEL: For one, brain research is revealing how developmental dysfunction comes about and affects the way we process speech, auditory input, and language. Perhaps most exciting are the advances in brain-machine-interface technology that are beginning to allow people with devastating neurological conditions (e.g., “locked in” syndrome — a situation in which people are unable to move a muscle or utter a sound) — as well as severe head injuries, spinal injuries, and amyotrophic lateral sclerosis (Lou Gehrig’s Disease) — to communicate. This is nothing short of amazing. The electrodes are placed around the head and record the patient’s electrical brain waves. A computer analyzes and translates the electrical energy generated by the patient into discrete commands, such as writing e-mails, selecting computer icons, or moving robotic devices.

LOPEZ: “The fact that addiction is associated with neuro-biological changes is not, in itself, proof that the addict is unable to choose.” Is our popular — and scientific — approach to addiction all wrong?

SATEL: No, not all wrong. But the mantra that “addiction is a brain disease” is deeply misleading. If your goal is to treat addicts or to develop policies in their best interest, an emphasis on the brain is simply not very helpful. It’s true that repeated use of drugs such as heroin, cocaine, alcohol, and nicotine do change the brain (this is the rationale behind naming addiction a “brain disease,” according to the National Institute on Drug Addiction). And those changes make quitting hard.

But the “brain disease” of addiction is not beyond the control of the addict in the same way that Alzheimer’s disease or multiple sclerosis are beyond the control of the afflicted. Showing how the two differ is an important theme of the chapter on addiction. We use addiction as a good example of neurocentrism — the bias toward seeing the brain as the most useful source of information about behavior. The problem with the brain-disease model of addictionis that it leaves the person in the shadows. This is a troubling because it distracts us from the fact that people begin using drugs, maintain excessive use, and decide to quit for reasons. Understanding those reasons is critical to recovery.

LOPEZ: Why did you dedicate the book to James Q. Wilson?

SATEL: Not only do I admire James Q. Wilson greatly, I had the honor to know him through AEI, where he was the chairman of the academic advisory council. In his 1993 book, The Moral Sense, Wilson was impatient with moral relativism and the idea that man was primarily a product of his culture. He argued that a moral sense was part of our basic nature, rooted in evolutionary biology, yet he took issue with the over-correction to cultural determinism borne by rigid biological explanations of human behavior. In recent years, Wilson was writing about genetic determinism and had just begun to write about neurodeterminsim. I think that he would have turned more fully to popular brain science and its excesses as the next phase of his interest in “the moral sense.”

LOPEZ: “When a person commits a crime, who is at fault: the perpetrator or his or her brain?” You accuse this question of a “false distinction.” But what if the perpetrator is mentally ill? Wouldn’t it only be fair and just to make the distinction?

SATEL: The law does indeed accommodate people with severe mental illness whose rationality is seriously impaired as a consequence of the illness. The insanity defense may apply to such individuals. More generally, it is important to understand the relationship between cause and excuse under the law. The law’s concept of the person is that of an agent who is capable of acting at will and of offering reasons for his or her actions. Rationality is the hallmark of responsibility. There may be myriad reasons why people commit crimes, but no matter the explanation — from bad neurons to bad parents to bad stars — defendants will be found legally blameworthy as long as their rational capacity remains largely intact. Obviously, if causation alone served to excuse behavior, then all behavior would need to be excused, and no one could ever be held responsible for his or her actions. Biological causes are accorded no special weight in the eyes of the law, even though many people harbor the intuition that they should wield more clout.

LOPEZ: Was the Supreme Court’s verdict in Roper v.Simmons based on revelations in brain science?

SATEL: The 2005 Simmons ruling banned the execution of offenders whose crimes were committed before age 18. There is little to no evidence that the Court ruled in this manner on the basis of presented evidence that the teen brain is biologically immature, yet many juvenile-justice advocates credited the brain science with persuasive power.

The majority of the justices were right to regard the neurobiological evidence as telling them nothing new about teen behavior. After all, Christopher Simmons — a teen who killed a woman after breaking into her home — did not need to possess a fully formed brain to know that throwing a hog-tied person off a bridge is wrong. An average nine-year-old grasps the finality of death. Although the neuroscience of the adolescent brain helps us construct a plausible biological account of why adolescents can be more impetuous than adults, it says little about any individual teen offender. A case-by-case approach makes the most sense. To be sure, there are compelling ethical reasons for eliminating the death penalty for juvenile killers. But the idea that the neurobiology of their collective brains should categorically exclude teens from certain forms of punishment is a shaky proposition.

LOPEZ: “The vast majority of teens who harbor fantasies of violence do not act on them,” you write. Then do we need to rethink some of our strategies about deciphering warning signs?

SATEL: The best predictor of future behavior is usually past behavior. It’s an old rule of thumb but it’s still true. Efforts are underway to try to predict violence by detecting patterns of brain activity, but such “neuro-prediction,” as it is called, is not yet fit for use. The accuracy is too low and thus too many nonviolent people are classified as potentially violent.

A few months ago, researchers reported that reduced activity in a region of the brain called the anterior cingulate cortex (ACC) could predict subsequent rearrest among adult offenders within four years of release. But the prediction was far from perfect. Forty percent of the reduced-ACC-activity parolees did not reoffend and 46 percent of higher-ACC parolees did. The study was impressive (good sample size, great follow-up with subjects), but who would seriously dream of breaching a person’s liberty based on findings that are so imprecise? Not the authors of the paper, as they made clear.

But, maybe we’ll get a lot better at prediction. I’m skeptical that we’ll ever get good enough — and how good is good enough? 90 percent? 99.99999 percent? — to justify detaining people prior to the commission of a crime. But the key lesson here is that the issue of where to draw the line on an acceptable level of risk is not a scientific one. Data inform these decisions, but, in the end, they come down to deliberation among citizens, experts, and policymakers.

Predicting violent behavior in teens or adults will always be hard because there is such a low base rate of these behaviors and the risk of false positives (thinking you’ve detected a future mass killer when you haven’t) is so high. As far as school-based disasters go, it seems that efforts are best directed at facilitating communication among students and faculty because it is often the case that students who plan mayhem tell their friends.

LOPEZ: “It is a serious mistake to think that one can erect an ethical system based on science alone.” Is the idea of a science-based ethical system the reigning view today?

SATEL: It’s not dominant among scientists because most scientists are not that interested in stepping out of the lab. They live to design experiments and to make discoveries. And, to their chagrin, write grants.

Yet a number of prominent scientists seem intrigued by the idea that knowledge about the brain will guide us in our social interactions. No less towering a figure than neuroscientist Michael Gazzaniga hopes for a “brain-based philosophy of life” based on an ethics that is “built into our brains. A lot of suffering, war, and conflict could be eliminated if we could agree to live by them more consciously.”

According to neuroscientist Sam Harris, “the more we understand ourselves at the level of the brain, the more we will see that there are right and wrong answers to questions of human values.” How so? Neuroscience can help answer questions about the neural processes involved in moral decisionmaking and empirical facts can help us act more effectively on our values — for instance, if we value rehabilitation of prisoners then we’ll want to do it more effectively and we will need good data on new therapies. But it is not at all evident how discoverable facts about the brain can constitute a prescription for the way things should be.

Of course, the idea that science is the only source of human knowledge or the only way to enhance the quality of life is not new. We can trace it to the Scientific Revolution of 17th-century Europe. The fruits of that revolution have been among the greatest gifts to mankind, but the proper stance of scientists, as all good investigators know, is to respect the bounds of their discipline. This is true of all specialists.

LOPEZ: What are the implications of neuroscience for individuals’ freedom of choice?

SATEL: This is a momentous question. Our final chapter, called “The Future of Blame” (an homage to James Q. Wilson, who wrote an article with that title) is devoted to this topic. Our specific aim was to address the question “can neuroscience resolve the free will debate?” Heaven knows, neither Scott nor I can resolve it. But neither can neuroscience. Everyone agrees that people can be held accountable only if they have freedom of choice. The longstanding debate is about the kind of freedom that is necessary. Some contend that we can be held accountable as long as we are able to engage in conscious deliberation, follow rules, and generally control ourselves.

Others disagree, insisting that our deliberations and decisions do not make us free because they are dictated by neuronal circumstances. They believe that as we come to understand the mechanical workings of our brains more fully, we’ll be compelled to adopt a strictly utilitarian model of justice in which criminals are “punished” solely as a way to change their behavior, not because they truly deserve blame.

Which “option” you choose — what kind of freedom you deem sufficient — is a philosophical question, not a neuroscientific one. (Spoiler: I endorse the first.)